Assembly Registration
Complete this form for the church's portion of the registration process.  There will also be a church release form completed within the past year and a completed Assembly release form needed to complete your registration.
Youth Name *
Youth phone number
Grade just completed *
Required
T-shirt size
Diet restrictions or allergies
Medical needs, including medications and frequency, self-administered or needs assistance, other special needs
Parent name(s)
Parent phone number(s)
Parent Email *
Roommate Request - We will be staying in dorms at Hendrix.  This will likely be 2 to a room.  We will do our best to accommodate your request, but this is not guaranteed!
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